Yoga may reduce migraine frequency, intensity

Adding a yoga regimen to medical therapy reduced the frequency and intensity of headaches among patients with episodic migraine, according to results of the CONTAIN trial.

“Migraine is one of the most common headache disorders, but only about half the people taking medication for it get real relief,” said study author Dr Rohit Bhatia from the All India Institute of Medical Sciences (AIIMS), New Delhi, India. “The good news is that practising something as simple and accessible as yoga may help much more than medications alone. And all you need is a mat.”

The single-centre study conducted at AIIMS included 160 patients aged 18–50 years with episodic migraine (with or without aura; ≥4 but <14 headaches/month) who were randomized 1:1 to receive conventional medical therapy alone (mean age 31.9 years, 66.25 percent female) or in addition to a standardized yoga regimen* for 3 months (yoga group; mean age 30.5 years, 72.5 percent female). All patients were counselled on lifestyle modifications. A total of 114 patients completed the trial. Patients with a history of neurological disease were excluded.

Baseline demographics and headache characteristics were similar between treatment groups, though headache was more frequent in the yoga than the medical group (mean 9.1 vs 7.7 per month; p=0.012).

Both therapies had a positive effect on migraine outcomes. “There was a gradual improvement in clinical outcome measures in both groups but trend towards improvement was faster and more consistent in the yoga group compared to the medical group,” said the authors.

Better outcomes with yoga

At 3 months, the addition of yoga to medical therapy led to a 48 percent reduction in headache frequency (delta difference, 3.53, 95 percent confidence interval [CI], 2.52–4.54; p<0.001) compared with a 12 percent reduction with medical therapy only. [Neurology 2020;94:1-10]

There were also significant reductions in headache intensity (delta difference, 1.31, 95 percent CI, 0.60–2.01) and Headache Impact Test–6 scores (delta difference, 8.0, 95 percent CI, 4.78–11.22; p<0.001 for both) at 3 months with yoga vs medical therapy. 

Headache-specific disability based on Migraine Disability Assessment score was also reduced with yoga vs medical therapy (delta difference, 7.85, 95 percent CI, 4.98–10.97), as was the number of acute rescue pills taken, with a 47.3 percent vs 12 percent reduction in pill count (delta difference, 2.28, 95 percent CI, 1.06–3.51; p<0.001 for both).

“Our results show that yoga can reduce not just the pain, but also the treatment cost of migraines. That can be a real game changer, especially for people who struggle to afford their medication. Medications are usually prescribed first, and some can be expensive,” said Bhatia.

More patients in the yoga than medical therapy group were headache-free – defined as no use of acute medications – at 3 months (12.28 percent vs 0 percent; p=0.006).

There were three reports of adverse events in the medical therapy arm (two of weight gain and one of dry mouth) and one in the yoga arm (weight gain) during the study.

Mechanism of action

Improved vagal tone and decreased sympathetic activity, improved cardiac autonomic balance, increased nitric oxide levels, reduced tension, and loosening of stiff muscles are mechanisms that could explain the benefit of yoga in migraines, said the authors.

“We postulate that positive effects of yoga in this study could be related to a multidimensional effect of this intervention acting through both central and peripheral mechanisms, including physical, biochemical, psychological, and autonomic pathways mediating pain generation and spread,” they added.

Further research is necessary to determine the long-term benefits of yoga, as well as the comparative effects of yoga vs best medical therapy in patients with migraine, they noted.